Archive for June 2016

The fear of unnecessary cuts and the desire to have a natural and private delivery are prompting women to have their babies at home. Not surprisingly, this has led to a demand for trained midwives, says Sonia Sarkar
Three years ago, when 30-year-old Bincy Shibu Thomas of Cochin went into labour at 2am, she was not rushed to the hospital. Instead, she called a midwife home. The midwife delivered her second child, a baby girl, in the comfort of her own bedroom, with her husband and two-year-old daughter by her side.

“It was a happy and intimate experience,” says Thomas, a homemaker married to a software engineer. “It was so smooth that none in my building got to know that a child was born in my house,” she adds. Thomas opted for a midwifery-assisted birth again for her third child last year.

Kundo Yumnam, a 32-year-old Imphal-based entrepreneur, gave birth to a baby boy last December at home. “Lots of people had been scared of what was going on in the bedroom, not realising it was how birth happens naturally. Some still think I was crazy to have had my home birth without medical interventions, while others have changed their opinion and said that it was brave of me,” she says.

More and more women from middle- and upper-middle class families across India are reaching out to midwives because they say they want the process of childbirth to be natural and safe, and only midwives can ensure that.

“In a month, at least 10 women ask about midwifery-assisted home birth. Four years ago, there were just one or two inquiries,” says Manjari Kawde, a Mumbai-based gynaecologist and obstetrician who runs Beams Hospital.

Independent studies on childbirth second this. In her paper, Childbirth Narratives: Voices of Educated Urban Women, Subarna Ghosh, a researcher with Mumbai’s SNDT Women’s University, says five out of the nine women she interviewed for her paper had a midwifery-assisted birth. “Affluent women are engaging midwives who are trained abroad or have come from the West. They keep doctors only as a back-up option,” Ghosh says.
Kanika Aswani with her husband and child
The demand for midwives is also linked to the fact that hospital births are seen as impersonal. “Midwives do their work with love and care. Women need that most when they are birthing,” says Hyderabad-based practising midwife Vijaya Krishnan, a graduate of New Mexico’s National College of Midwifery. Krishnan’s role typically starts around the 12th week of a pregnancy and continues for six weeks after the birth. Charges vary between Rs 45,000 and Rs 1.5 lakh, depending on the city.

Many women prefer having their babies at home because hospitals are too public. “In the hospital everyone is watching me writhe in pain. At home, it was my own space. I felt safe, comfortable, not agonised,” says Mumbai-based reiki healer Kanika Aswani, who gave birth to a baby girl two years ago.

Couples also appreciate the fact that husbands have a more active role to play in midwifery-assisted births. “They massage and encourage their wives. They are aware of all their choices, pros and cons of any intervention, and can make effective decisions without getting into a flap,” says Thomas’s midwife Priyanka Idicula, a certified midwife and director of Birthvillage Natural Birthing Center, Cochin.

But in a country where babies were once mostly delivered by midwives, only a handful of them are trained and registered. The World Health Organization (WHO) states that the density of nurses and midwives in India is 17 per 10,000 population, which is low compared to Finland’s 108 and Britain’s 88. The midwives available in large numbers are either traditional birth attendants (such as a dai) or those who have completed a two-year auxillary nurse and midwifery programme. They, however, are not equipped to play an active role in birthing and merely assist doctors.

Childbirth with the help of midwives has been popular among poorer people, but of late the government has been promoting institutional deliveries among them to check maternal mortality rates.

The ones in demand are those who have received advanced training. “Only some of us, who are adequately trained in midwifery, can handle cases holistically like our counterparts in countries such as Britain, New Zealand and the Netherlands which promote midwifery-assisted home birth,” says Lina Duncan, who runs Mumbai Midwife, a private midwifery practice.

These trained midwives, equipped to deal with issues such as vaginal bleeding, irregular movements of the baby, emotional disturbances and mental trauma of the mother during pregnancy, can administer emergency medication during birthing. They also provide check-ups, nutrition counselling and baby-care training later. Some provide services at home and a few run their own centres. There are also foreign nationals, trained as midwives, who deliver the services and often tie up with obstetricians, who support home births.

Another oft-quoted advantage of midwifery-assisted home birth is that midwives are on call 24×7, unlike doctors. Medically too, the benefits of midwifery assisted home birth are plenty. “Post-natal depression is lower among women who opt for home birth. Risk of infection among babies is lower too,” says Ruth Malik, founder of Birth India, a Mumbai-based NGO to promote safe childbirth practices.

Experts also feel that the new midwifery assisted birth options have empowered women to take a decision of their own, in child birth. “Traditionally, in India, even if the woman is educated, everyone else would decide for her, when she is pregnant. At least, home birth options are giving them a ‘better’ or ‘braver’ choice of child birth leading to their empowerment and satisfaction,” Ghosh adds.

One reason why pregnant women are opting for midwives is the increase in Caesarean (C-section) deliveries. Often, hard pressed doctors find it easier to deliver a C-section baby than wait for a natural birth to occur. Delhi-based Divya Deswal, who runs Birth Bonds, an NGO that provides childbirth support, believes that doctors also instil a sense of fear among expectant mothers.

“In most cases, mothers have been told there are problems with normal delivery, so they are forced to go for a Caesarean or an induced birth,” says Deswal, a doula and hypnobirth practitioner. Doula is the term for a birth companion and post-birth supporter, while hypnobirthing is a childbirth process that uses a combination of techniques – breathing methods, positive thoughts/language, deep relaxation and visualisation – to remove fear. A lot of women also opt for midwifery-assisted birth for their second child, because they want to forget their previous traumatic experience.

Thomas recalls how the doctor induced labour during her first pregnancy. She had to lie down for 12 hours before her child was born. “Before the delivery, an episiotomy (surgical cut at the opening of the vagina) was made. It was painful and the doctor never took our permission,” she says.

According to WHO guidelines, only 10-15 per cent of births in India require surgical intervention. Another WHO study that reviewed 1,10,000 births from nine countries in Asia, including India, in 2010 revealed that in hospitals where Caesarean births took place, more than 60 per cent was done for financial gains and not because surgery was required.

“Women being led to agree to Caesarean surgery on the basis of false information, like C-section is safer than vaginal birth or telling them their baby might die without the surgery when the baby is absolutely fine, is a violation of the human right to autonomy,” says Hermine Hayes-Klein, executive director, Hague-based Human Rights in Childbirth, an international NGO.

Gynaecologists, however, are not convinced that midwifery-assisted home birth is a feasible option in India. Renu Misra, a senior consultant at the Delhi-based Sitaram Bhartia Institute of Science & Research, says such births are feasible in countries which have a community health service integrated with higher centres. “There, a woman can be transported to a hospital in no time if she develops a complication,” she says.

But women like Thomas are happy with their midwives. For them, the transition to motherhood is less scary and painful.

a shorter version of the story appeared in The Telegraph on June 26,2016.

– Words, sometimes, can be more baffling than illuminating. As people struggle over a particularly verbose verdict, legal experts tell Sonia Sarkar that brevity, simplicity and clarity are important parts of a judgment

Justice delayed, as the old saying goes, is justice denied. But what about justice misread? What happens when a verdict is worded in such a way that it is not easy to understand what is being said?

That wordy judgments can be difficult to understand was brought to the fore last month when a Supreme Court bench was giving its verdict on the issue of defamation.

“This batch of writ petitions preferred under Article 32 of the Constitution of India exposits cavil in its quintessential conceptuality and percipient discord between venerated and exalted right of freedom of speech and expression of an individual, exploring manifold and multilayered, limitless, unbounded and unfettered spectrums and the controls, restrictions and constrictions, under the assumed power of ‘reasonableness’ ingrained in the statutory provisions relating to criminal law to reviver (sic) and uphold one’s reputation,” Justice Dipak Misra said in a 268-page long judgment in the Subramanian Swamy vs Union of India case.

Faced with a convoluted sentence such as this, it is not surprising that there is growing demand for simply phrased judgments. “Brevity, simplicity and clarity are the essentials of a good judgment,” says (Retd) Justice Sunil Ambwani, former Chief Justice of the Rajasthan High Court. “Sometimes, judges emulate Shakespeare. But they don’t know that little Shakespeare is fatal to justice,” adds former Law Commission chairperson Upendra Baxi.

What constitutes a sound verdict? Reasoning, and the result of that, holds Baxi, who teaches law at the University of Warwick, UK. Verbosity is not a sign of a good judgment, he points out. “Judges should never use flowery language which becomes incomprehensible. One should not need a dictionary to understand a judgment.”

The importance of language lies not just in the fact that it should read or sound well. Legal experts stress that the essence of a verdict should not get lost in the language. A verdict becomes unclear if the wording is not sharp. And that can lead to justice being derailed.

The experts point out that judges should bear in mind that judgments are written for aggrieved parties, lawyers, appellate courts, law students and for society at large. That’s the primary reason why it should be written in an understandable language, they add.

The Supreme Court, too, is aware of the pitfalls of verbosity. It laid out guidelines on the writing of judgments in 2010. It said that “appropriate care” should be taken to not load a verdict with all legal knowledge on a subject as citing too many judgments could lead to confusion rather than clarity.

The movement against incomprehensible judgments has been gaining ground for a while now. The issue was taken up by former Supreme Court Justice R.V. Raveendran in an article titled “Rendering Judgments — Some Basics” in 2009, a collection of lectures that he delivered at the National Judicial Academy in Bhopal. The unwarranted use of legalese, hackneyed phrases and clichés should be avoided in a judgment, he writes.

Justice Ambwani, who wrote around 10,000 judgments in his career as a judge, seconds it. “Plain and simple language has always been appreciated in writing judgments,” he writes in a brochure on “Skills of Judgment Writing” by the Judicial Training and Research Institute, Lucknow. “The greatest of these is clarity. It is better to avoid invidious examples, unnecessary quotations, and lecture.”

There was a time when judges were known for their crisp language. Former Supreme Court Chief Justices M. Patanjali Sastri and P.N. Bhagwati were particularly admired for their language, Baxi says.

Inadequate knowledge of English is often held up as a sign of badly written judgments, but perhaps the issue goes beyond that. Not every judge is fluent in English, for they come from different states, and have different socio-economic backgrounds.

“I knew one judge who used to go through the editorials of newspapers and picked up words from there. He used those words in his order even if there was no need for them,” ex-Justice Ambwani says.

Last month, a Supreme Court bench consisting of Justice Abhay Mohan Sapre and Justice Ashok Bhushan objected to a high court judge passing an order in English which was erroneous on account of grammar, syntax, usage of words and punctuation, and sent the order back to the subordinate court and asked him to issue a fresh order.
But knowledge of English is not essentially a sign of a well-written judgment, and not all scholarly judges are lucid. Baxi believes that some verdicts of V.R. Krishna Iyer — known for scores of path-breaking judgments — were often difficult to understand.

“It is true that Justice Iyer has his authentic brand of self-expression which frequently violates canons of good English as well as good legalese,” Baxi is quoted as saying in the book Justice V.R. Krishna Iyer on Fundamental Rights and Directive Principles, written by Shailaja Chander.

To ensure that judges write using simple words, the National Judicial Academy in Bhopal and 22 academies run by different states have started compulsory courses for judges with special emphasis on writing judgments.

“Very few judges have good command over language. They use flowery language because they think that’s how a good judgment is written,” Geeta Oberoi, acting head of the National Judicial Academy, says.

The Delhi Judicial Academy, which too conducts courses for judges, has been focusing since 2014 on writing judgments. “We invite English professors who tell judges how to construct sentences in simple words. They also tell them how to keep the essence of judgments intact. A judgment should not be verbose,” an officials says.

“Judgment should always be to the point. To enrich the judgment with language style may not be very desirable. If one gets lost in the language, one loses the grip over the main issue,” former Supreme Court judge V.D. Tulzapurkar said in the Manohar Nathurao Samarth vs Marotrao and Others case (1979).

In the brochure on judgment writing, retired Justice Ambwani stresses the need to adopt short words and avoid long sentences. Minimise jargon and technical terms and avoid double or triple negatives, he wrote. “No reader wants to wrestle with sentences,” he warned.

Justice Misra’s sentence was 73 words long. And, indeed, it called for some serious wrestling.

Prakton made me realise a few things related to a man-woman relationship. A movie which didn’t really capture the correct image of an independent woman but could rightly portray a “modern” man, gave us a few lessons of life.

Here is my takeaway.

A man could be very progressive professionally but he could be absolutely traditional in his personal space. A man, may get attracted to you, because you are independent and forthright but he would still like to be domineering. He would be proud of your “achievements” ( it’s a disputed word though) but he would be uncomfortable if you are praised a little too often.

So never try to adjust with a wrong person. Understand the early signals and move on. It will hurt you a lot, sometimes, for next few years (if you are extremely sensitive person and slow to changes) but you will torture yourself if you linger on.

After many years, he might tell you that you still occupy a part of his mind but he would not like to be with you for all the qualities that you have.

He would choose to be with a “not-so complicated” woman because this gives him more peace.There is no questioning. There are no arguements. Since his word is the last word, there is absolute peace.

But this movie also tells you to respect the fact that some women, amongst us, believe in sacrificing and compromising because that’s where they find happiness.Don’t look down upon them because their larger goal is also to be at peace. You may not approve of their ways of seeking peace.